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Emergency Department Administration

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https://www.readbyqxmd.com/read/28550443/timing-to-antibiotic-therapy-in-septic-oncologic-patients-presenting-without-hypotension
#1
Kathleen Morneau, Gary B Chisholm, Frank Tverdek, Jeffrey Bruno, Katy M Toale
PURPOSE: Sepsis accounts for only 2% of the hospitalizations worldwide but more than 17% of total in-hospital mortality. Inappropriate antimicrobial selection and delays in appropriate therapy have been associated with reduced survival in severe sepsis and septic shock. No studies to date have exclusively targeted septic oncologic patients without hypotension. METHODS: This study was a retrospective chart review of 100 adult cancer patients presenting to the emergency department with sepsis without hypotension...
May 26, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28547273/case-distribution-and-complications-of-mid-urethral-sling-surgery-in-a-canadian-city-before-and-after-the-health-canada-advisory-on-pelvic-floor-mesh
#2
Kevin Carlson, Richard Baverstock, Andrea Civitarese, R Trafford Crump
INTRODUCTION AND HYPOTHESIS: Increased incidences of complications related to the use of mid-urethral slings (MUS) for the treatment of stress urinary incontinence resulted in both the Food and Drug Administration (FDA) and Health Canada issuing advisories in 2008 and 2010 respectively. The purpose of this study was to assess the effect these advisories had on the number of surgeons performing MUS surgery and post-surgical complications in Calgary, Canada. METHODS: In this study, we conducted a retrospective analysis of administrative data between 2006 and 2011...
May 25, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28546381/adjunct-therapies-for-refractory-status-asthmaticus-in-children
#3
Kyle J Rehder
Asthma exacerbation is a common reason for children to present to the emergency department. If primary therapies fail to halt the progression of an asthma flare, status asthmaticus often leads to hospital, and potentially ICU, admission. Following the initial administration of inhaled β agonists and systemic corticosteroids, a wide array of adjunct medical therapies may be used to treat status asthmaticus. Unfortunately, the data supporting the use of these adjunct therapies are often unclear, conflicting, or absent...
June 2017: Respiratory Care
https://www.readbyqxmd.com/read/28545752/emergency-department-as-a-first-contact-for-mental-health-problems-in-children-and-youth
#4
Peter J Gill, Natasha Saunders, Sima Gandhi, Alejandro Gonzalez, Paul Kurdyak, Simone Vigod, Astrid Guttmann
OBJECTIVE: To characterize youth who use the emergency department (ED) as a "first contact" for mental health (MH) problems. METHOD: This was a population-based cross-sectional cohort study using linked health and demographic administrative datasets of youth 10 to 24 years of age with an incident MH ED visit from April 1, 2010, to March 31, 2014, in Ontario, Canada. We modeled the association of demographic, clinical, and health service use characteristics with having no prior outpatient MH care in the preceding 2-year period ("first contact") using modified Poisson models...
June 2017: Journal of the American Academy of Child and Adolescent Psychiatry
https://www.readbyqxmd.com/read/28545484/timing-of-appropriate-empirical-antimicrobial-administration-and-outcome-of-adults-with-community-onset-bacteremia
#5
Ching-Chi Lee, Chung-Hsun Lee, Ming-Yuan Hong, Hung-Jen Tang, Wen-Chien Ko
BACKGROUND: Early administration of appropriate antimicrobials has been correlated with a better prognosis in patients with bacteremia, but the optimum timing of early antibiotic administration as one of the resuscitation strategies for severe bacterial infections remains unclear. METHODS: In a retrospective cohort study, adults with community-onset bacteremia at the emergency department (ED) were analyzed. Effects of different cutoffs of time to appropriate antibiotic (TtAa) administration after arrival at the ED on 28-day mortality were examined, after adjustment for independent predictors of mortality identified by multivariate regression analysis...
May 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28544364/influenza-associated-delays-in-patient-throughput-and-premature-patient-departure-in-emergency-departments-in-new-south-wales-australia-a-time-series-analysis
#6
David J Muscatello, Kendall J Bein, Michael M Dinh
OBJECTIVES: Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia. METHODS: This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects...
May 24, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#7
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542027/retrospective-population-based-study-of-emergency-medical-services-attended-out-of-hospital-cardiac-arrests-in-children-in-belgium
#8
Sophie Vandeplassche, Patrick van de Voorde
OBJECTIVE: This study presents an analysis of clinical data of the circumstances and outcome of paediatric (0-16 years) out-of-hospital cardiac arrests (p-OHCA) in Belgium. METHODS: This was a retrospective study of a prospective population-based registration of physician-attended [mobile emergency group (MUG)] emergency medical services (EMS) interventions of p-OHCA in Belgium between 2010 and 2012. RESULTS: We identified 365 OHCA in 18 295 paediatric MUG interventions (2%)...
May 24, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28541419/acute-toxicity-from-intravenous-use-of-the-tricyclic-antidepressant-tianeptine
#9
Sara K Dempsey, Justin L Poklis, Kacie Sweat, Kirk Cumpston, Carl E Wolf
Tianeptine (7-[([3-chloro-6,11]-dihydro-6-methyldibenzo[c,f][1,2]thiazepin-11-yl) amino] heptanoic acid S, S dioxide) is a tricyclic compound prescribed as an antidepressant in European countries, but is not currently approved for use in the United States. There are few published case reports of tianeptine intoxication. Presented is the first case of acute toxicity associated with the intravenous use of tianeptine. A 36-year-old male intentionally injected tianeptine powder intravenously to "help him see into the future"...
May 24, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28535109/intranasal-steroid-use-for-otitis-media-with-effusion-ongoing-opportunities-for-quality-improvement
#10
David E Wang, Derek J Lam, Angela M Bellmunt, Richard M Rosenfeld, Allison K Ikeda, Jennifer J Shin
Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed...
May 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28528569/time-to-treatment-and-mortality-during-mandated-emergency-care-for-sepsis
#11
Christopher W Seymour, Foster Gesten, Hallie C Prescott, Marcus E Friedrich, Theodore J Iwashyna, Gary S Phillips, Stanley Lemeshow, Tiffany Osborn, Kathleen M Terry, Mitchell M Levy
Background In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. Methods We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care for patients with sepsis (i...
May 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28523416/utility-of-ct-oral-contrast-administration-in-the-emergency-department-of-a-quaternary-oncology-hospital-diagnostic-implications-turnaround-times-and-assessment-of-ed-physician-ordering
#12
Corey T Jensen, Katherine J Blair, Ott Le, Jia Sun, Wei Wei, Brinda Rao Korivi, Ajaykumar C Morani, Nicolaus A Wagner-Bartak
PURPOSE: To compare studies with and without oral contrast on performance of multidetector computed tomography (CT) and the order to CT examination turnaround time in cancer patients presenting to the emergency department (ED). To the best of our knowledge, oral contrast utility has not previously been specifically assessed in cancer patients presenting to the emergency department. MATERIALS & METHODS: Retrospective review of CT abdomen examinations performed in oncology patients presenting to the emergency department during one month...
May 18, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28522680/geographic-clustering-of-emergency-department-presentations-for-acute-coronary-syndromes-and-heart-failure-in-alberta-a-population-based-study
#13
Rhonda J Rosychuk, Brian H Rowe, Finlay A McAlister
BACKGROUND: Collectively, the most common acute cardiac presentations to emergency departments are acute coronary syndromes (ACSs) and heart failure. We examined geographic variation and clustering in emergency department presentations by adults for ACS or heart failure in Alberta in 2010/11. METHODS: All emergency department presentations for ACS or heart failure made by Alberta residents aged 35 years or more during 2010/11 were extracted from 5 linked population-based Alberta administrative health databases...
May 18, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28521715/conducting-hiv-seroprevalence-and-behavioral-epidemiology-risk-surveys-sabers-among-partner-military-populations
#14
Caroline A Macera, Stanley I Ito, Braden R Hale, Richard A Shaffer, Anne G Thomas, Janet Dickieson
BACKGROUND: Characterizing HIV infection and associated risk behaviors within military populations is critical for understanding the epidemic and informing prevention activities. However, the prevalence of HIV and related risk behaviors is often unknown. Further, militaries may not have the systems in place or the staff expertise to conduct HIV surveillance and risk behavior studies. METHODS: The Department of Defense HIV/AIDS Prevention Program (DHAPP), funded by the President's Emergency Plan for AIDS Relief and the US Department of Defense, provides technical assistance, management and administrative support for HIV/AIDS prevention, care and treatment for approximately 65 partner militaries...
May 16, 2017: Current HIV Research
https://www.readbyqxmd.com/read/28514322/relationship-between-a-sepsis-intervention-bundle-and-in-hospital-mortality-among-hospitalized-patients-a-retrospective-analysis-of-real-world-data
#15
Priya A Prasad, Erica R Shea, Stephen Shiboski, Mary C Sullivan, Ralph Gonzales, David Shimabukuro
BACKGROUND: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. METHODS: We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS)...
May 12, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28511107/frequent-emergency-department-presentations-among-people-who-inject-drugs-a-record-linkage-study
#16
Dhanya Nambiar, Mark Stoové, Paul Dietze
BACKGROUND: People who inject drugs (PWID) have been described as frequent users of health services such as emergency departments (EDs), however few studies have described demographic factors, patterns of substance use and previous health service use associated with frequent use of EDs in this population. METHODS: Using a combination of self-reported data from a cohort of PWID and administrative ED data obtained through record linkage, we identified longitudinal factors associated with the use of ED services...
May 13, 2017: International Journal on Drug Policy
https://www.readbyqxmd.com/read/28504322/racial-differences-in-the-pain-management-of-children-recovering-from-anesthesia
#17
Olubukola O Nafiu, Wilson T Chimbira, Margaret Stewart, Kathleen Gibbons, L Kareen Porter, Paul I Reynolds
BACKGROUND: When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the postanesthesia care unit. METHODS: This is a prospective, observational, study of 771 children aged 4-17 years who underwent elective outpatient surgery...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28501258/impact-of-hospital-admission-for-patients-with-transient-ischemic-attack
#18
Eric M Cheng, Laura J Myers, Stefanie Vassar, Dawn M Bravata
OBJECTIVES: To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED). STUDY DESIGN: Retrospective cohort study using national Veterans Health Administration data (2008). METHODS: We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching...
May 10, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28501069/emergency-department-utilization-related-to-dental-conditions-and-distribution-of-dentists-nebraska-2011-2013
#19
Sankeerth Rampa, Fernando A Wilson, Rajvi Wani, Veerasathpurush Allareddy
PURPOSE: This study aims to provide estimates of hospital-based emergency department (ED) visits due to dental conditions in Nebraska and to examine patient-related characteristics associated with ED charges. In addition, this study provides dental-related ED visits and distribution of dentists by county. METHODS: For the study, we used the State Emergency Department Database for Nebraska for the years 2011 through 2013 and the Health Resources and Services Administration's Area Health Resource File...
June 2017: Journal of Evidence-based Dental Practice
https://www.readbyqxmd.com/read/28500651/predictors-of-response-in-emergency-department-patients-receiving-intravenous-opioids-for-severe-pain
#20
Jacob A Radcliff, Rachel M Rafeq, Jane F Bowen, Laura Pontiggia, Sanchita Sen
OBJECTIVE: The primary objective of this study was to identify significant environmental and patient characteristics of emergency department (ED) patients who responded to intravenous (IV) hydromorphone and IV morphine for severe pain. Secondary objectives were to 1) investigate the individual effect of the significant environmental and patient characteristics of responders and 2) assess the nature and strength of the correlation of initial dose and change in pain score from arrival to pre-administration...
May 13, 2017: Pharmacotherapy
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